2023-2024 Town's Health Benefits Overview Guide
Document Date unknown · 53 page(s) in the original
This is the document's text, extracted automatically. Headings and paragraphs are inferred from the original's layout, so the arrangement may differ from the published version — the words do not. Where it matters legally, the original governs.
Health Benefits Guide 2023-2024 Town of Centreville Table of Contents Welcome to Your Health Benefits Guide ...................................................................................... 3 What’s New July 1 ......................................................................................................................... 4 Benefits Eligibility ......................................................................................................................... 5
When to Enroll ............................................................................................................................... 7 How to Enroll ................................................................................................................................. 7 Your Cost for Health Coverage .................................................................................................... 10
Medical and Pharmacy Coverage ................................................................................................. 11 Connect Care 3 ............................................................................................................................. 28 Pharmacy Coverage ...................................................................................................................... 29
Dental Coverage ........................................................................................................................... 30 Vision Coverage ........................................................................................................................... 31 On Your Way to Wellness............................................................................................................ 33
Prepare for the Unthinkable ......................................................................................................... 34 Protect Your Income! ................................................................................................................... 36 Additional Benefits ....................................................................................................................... 38
Employee Assistance Program (EAP).......................................................................................... 39 Retirement Plans – Planning Your Future ................................................................................... 40 Questions? .................................................................................................................................... 41
Annual Notices ............................................................................................................................. 42 Helpful Contacts ........................................................................................................................... 49 General Glossary of Terms .......................................................................................................... 50
2023 – 2024 Health Benefits Guide 2 Welcome to Your Health Benefits Guide Town of Centreville Local Government (“Town”) takes pride in offering a comprehensive and competitive benefits package to our employees. The Town, through all of our benefits partners, offers you a benefits program that allows choice and flexibility. Through this guide, you can select benefits that work best for you and your family.
2023-2024 Plan Year
• Benefits will be effective for the July 1, 2023 – June 30, 2024 plan year.
• The Town continues to evaluate ways to improve the quality of your healthcare and keep our health
plans competitively priced, while controlling costs for you and the Town. We encourage staff to become and remain engaged in these efforts by being educated on the plans and using them wisely. Be sure to participate in Employee Wellness programs and activities, and partner with your physician to get appropriate preventive screenings. Also, consider programs like mail order pharmacy and generic prescriptions to lower your copays and overall plan costs.
• When reviewing your benefits, please be aware of the difference between the following terms:
o Calendar Year – runs from January 1 to December 31 and resets each January 1.
o Plan Year – Town benefit plan year, which runs from July 1 to June 30.
o Every 12 months – a rolling 12 months that begins on the date of your most recent service.
It is important to take time to review the plan options available to you prior to making your selections. Consider each benefit and the associated costs carefully and choose the benefits package that will meet yours and your family’s needs throughout the year.
For details about each specific plan, review the sections in this guide or refer to the Helpful Contact section for contact information for each of the plans. OR Email Human Resources: kebaugh@townofcentreville.org for a copy of the specific plan document you are requesting.
THIS GUIDE IS NOT A CONTRACT
This guide is a summary of general benefits available to Town of Centreville employees and retirees and describes the highlights of our benefits in non-technical language. Our specific rights to benefits under the plan are governed solely, and in every respect, by the official documents and not the information in this summary. If there is any discrepancy between the descriptions of the programs as contained in this guide and the official
plan documents, the language of the official document shall prevail as accurate. Please refer to the planspecific documents for detailed plan information. Any plan benefits may be modified in the future to meet Internal Revenue Service rules as decided by the Town.
2023 – 2024 Health Benefits Guide 3 What’s New July 1
• New and improved Town’s Summary of Benefits format and will now be identified as the Health
Benefits Guide! Use the Table of Contents to search for topics that interest you.
• Healthcare Flexible Spending maximum annual contribution is now $2,850, with a $550 carry-over
• The following carriers have changed their company name, but have not changed their services. Please
note the changes below:
PLAN FROM TO
Flexible Spending Accounts Innovative Health Services CareFlex 457(b) Deferred Compensation ICMA-RC Mission Square 457(b) Deferred Compensation VALIC (AIG) Corebridge Financial
• Check out page 10 of this guide for health plan costs beginning July 1.
2023 – 2024 Health Benefits Guide 4 Benefits Eligibility Employee Eligibility All Town employees, as defined by Town of Centreville, are benefits eligible (full-time and permanent parttime).
Dependent Eligibility You may enroll your eligible dependents in the same plans you choose for yourself. Eligible dependents include your legal spouse, dependent children and disabled adult child. The Dependent Eligibility Documentation Requirements are outlined on page 8 of this guide.
The Town of Centreville provides a generous benefit package to eligible employees with benefit options from healthcare to income protection. The following chart outlines your benefit options for plan year:
July 1, 2023 – June 30, 2024 Benefit Options Plan Options Coverage Who Is Eligible* Medical and Pharmacy Cigna Choice Fund Open Begins the 1st day that all Regular Full-time Access Plus In-Network eligibility requirements employees working at are met if enrolling. least 40 hours per week.
Coverage ends on the last Regular Part-time day of employment or the employees working at date that the employee is least 20 hours per week.
no longer eligible.
Dental MetLife Begins the 1st day that all Regular Full-time eligibility requirements employees working at are met if enrolling. least 40 hours per week.
Coverage ends on the last Regular Part-time day of employment or the employees working at date that the employee is least 20 hours per week.
no longer eligible.
Vision National Vision Begins the 1st day that all Regular Full-time Administration, LLC eligibility requirements employees working at (NVA) are met if enrolling. least 40 hours per week.
Coverage ends on the last Regular Part-time day of employment or the employees working at date that the employee is least 20 hours per week.
no longer eligible.
2023 – 2024 Health Benefits Guide 5 Group Life and AD&D Lincoln Financial Group Begins the 1st day that all Regular Full-time Insurance eligibility requirements employees working at are met if enrolling. least 40 hours per week.
Coverage ends on the last day of employment or the date that the employee is no longer eligible.
Voluntary Life Insurance Lincoln Financial Group Begins the 1st day that all Regular Full-time eligibility requirements employees working at are met if enrolling. least 40 hours per week.
Coverage ends on the last day of employment.
Continuing coverage may be available. Contact Lincoln Finance for more information of continuing coverage.
Flexible Spending CareFlex Begins the 1st day of the Active employees Accounts next month following working 30 or more hours your date of hire. per week or 130 hours per month and eligible for the group health plan.
Accident, Cancer, AFLAC Begins in the pay cycle Active employees Hospital, Critical Care following enrollment and confirmation of deduction by AFLAC Rep.
457 (b) Deferred Corebridge Financial Begins in the pay cycle Active employee or Compensation OR following enrollment and independent contractor of Mission Square confirmation of deduction the Town.
by Def Comp Rep.
*To be eligible, you must meet the eligibility requirements as outlined in the Eligibility section of this guide.
2023 – 2024 Health Benefits Guide 6 When to Enroll
NEW HIRE ELIGIBILITY* QUALIFYING LIFE EVENTS OPEN ENROLLMENT
As a newly hired benefits-eligible Certain events in your life (i.e., You must contact HR during employee, you are offered an marriage, divorce, gain or loss of Open Enrollment to make any initial enrollment period to elect coverage due to a job change, etc.) coverage changes for the benefits. allow you to make changes to your following year.
benefit plan(s). Open Enrollment is offered Elections made as a new hire will annually to give you the stay in effect for the entire plan If you experience a qualifying life opportunity to change, elect or year and cannot be changed until event during the plan year, you cancel benefits. It usually occurs the next plan year during Open must contact HR to make changes in May of each year.
Enrollment or within 30 calendar within 30 calendar days following days following a qualifying life the qualifying event date, even if event. the supporting documentation is not yet available.
EFFECTIVE DATE EFFECTIVE DATE EFFECTIVE DATE
Date of hire. Date of qualifying event. Open Enrollment elections will become effective July 1 of the next plan year.
*Town requests that all benefits-eligible employees contact Human Resources to elect or decline benefits.
How to Enroll This chart outlines how you enroll and the deadline for enrollment for each benefit. The Town is working diligently to provide employees the ability to enroll and make benefit change requests online.
HOW TO ENROLL DEADLINE TO ENROLL
WITHIN 14
CALENDAR DAYS
BENEFIT AUTO OF NEW HIRE
ONLINE PAPER DATE OR WITHIN NO DEADLINE
ENROLLED
30 DAYS OF A
QUALIFYING LIFE
EVENT
Health (Medical, Rx, X X Dental, Vision) Healthcare Flexible
X X
Spending Account (FSA) Dependent Care Flexible
X X
Spending Account (FSA) 2023 – 2024 Health Benefits Guide 7 Basic Life
X X
Insurance* Optional Life
X X
Insurance* MD State
X X
Retirement 457B – Deferred
X X
Comp
AFLAC X
(If enroll outside of
X
election period, contributions will be after tax) Christmas Club X September *Evidence of Insurability/medical underwriting is required for enrollment after new hire eligibility period.
Human Resources conducts the Town’s Open Enrollment process. If you would like assistance with making your elections, please contact HR at (410) 758-1180 ext.15 or by email at kebaugh@townofcentreville.org.
Town of Centreville partners with Benecon to administer our health benefits and is working to streamline future Open Enrollment processes.
Enrollment Reminders
• If you are adding a spouse and/or children onto your health insurance, you must submit
dependent documentation to Human Resources. A marriage certificate is required for a spouse and a birth certificate for each child being enrolled along with Social Security cards. A copy of the Social Security card will be required for any new dependent.
2023 – 2024 Health Benefits Guide 8 Making Changes to Lifestyle Change/Event Documentation Required Marriage Certificate & Social Your Benefits Marriage Security Cards The choices you make when you are first Divorce Divorce Decree eligible are in effect for the remainder of the plan year that ends on June 30. Once you enroll, you must wait until the next Open Separation Agreement where Enrollment period to change your benefits Legal Separation the terms of the agreement
or add or remove coverage for dependents, permit a change in coverage unless you have a qualifying event as defined by the IRS.
Birth Certificate or Adoption Birth or Adoption papers & Social Security Cards The following are examples of a qualifying life event:
• Marriage, divorce, legal separation, Change in employment status
No documentation required – annulment or death of a spouse from part-time to full-time or Human Resources will confirm
• Birth, adoption or placement for vice versa
adoption
• Loss of health coverage Your child loses eligibility for
No documentation required
• Change in your dependent’s dependent coverage
eligibility status because of age or any similar circumstance Your spouse gains or loses Letter from spouse’s employer coverage under another plan verifying the change Life event changes must be made within 30 days of the qualifying event.
You go on or return from No documentation required – leave of absence Human Resources will confirm 2023 – 2024 Health Benefits Guide 9 Your Cost for Health Coverage Your PER PAYCHECK payroll deductions for medical, dental, vision and pharmacy coverages are shown in the tables below. Premiums are deducted pretax from 24 paychecks, July 2023 through June 2024. Actual payroll amounts below may vary depending on coverage(s) elected.
Medical, Dental, and Vision Premiums Cigna Choice Fund Health Reimbursement Account (HRA) Open Access Plus In-Network (Cigna):
Silver Plan – 85/15 Coverage Level Employee Pays Town Pays Employee $72.33 $409.87 Employee + Child $133.80 $758.20 Employee + Spouse $166.40 $942.92 Family $202.56 $1,147.84 Deductible – Employee* $0 $2,000 Deductible – Family* $0 $4,000 Gold Plan – 85/15 Coverage Level Employee Pays Town Pays Employee $81.62 $462.51 Employee + Child $150.98 $855.56 Employee + Spouse $187.76 $1,063.96 Family $228.57 $1,295.21
Deductible – Employee* $0 $1,300 Deductible – Family* $0 $2,600
* The Town established a health reimbursement account (HRA) and contributes up to 100% to pay for your
eligible out-of-pocket expenses during the contract year.
Metropolitan Life Insurance Company (MetLife):
Dental Plan – 85/15 Coverage Level Employee Pays Town Pays Employee $1.98 $11.24 Family $6.26 $35.47 National Vision Administrators, LLC (NVA):
Vision Plan – 85/15 Coverage Level Employee Pays Town Pays Employee $0.35 $2.00 Family $0.88 $4.99 2023 – 2024 Health Benefits Guide 10 Medical and Pharmacy Coverage Main Features of Your Plan Town of Centreville offers Cigna Open Access Plus In-Network with HRA which gives you access to a quality network of doctors, hospitals, facilities and labs that have contracted with your plan, and is located across the
United States. Primary Care Provider (PCP) is optional but recommended to coordinate care. Cigna does not require a referral to see specialists. However, this plan covers you for in-network providers only. You will pay 100% of out-of-network care, except for emergencies. Both Cigna plans offered include medical, behavioral health, and Pharmacy coverage.
SILVER PLAN BENEFIT SUMMARY
2023 – 2024 Health Benefits Guide 11 2023 – 2024 Health Benefits Guide 12 2023 – 2024 Health Benefits Guide 13 2023 – 2024 Health Benefits Guide 14 2023 – 2024 Health Benefits Guide 15 2023 – 2024 Health Benefits Guide 16 2023 – 2024 Health Benefits Guide 17 2023 – 2024 Health Benefits Guide 18 2023 – 2024 Health Benefits Guide 19
GOLD PLAN BENEFIT SUMMARY
2023 – 2024 Health Benefits Guide 20 2023 – 2024 Health Benefits Guide 21 2023 – 2024 Health Benefits Guide 22 2023 – 2024 Health Benefits Guide 23 2023 – 2024 Health Benefits Guide 24 2023 – 2024 Health Benefits Guide 25 2023 – 2024 Health Benefits Guide 26 2023 – 2024 Health Benefits Guide 27 Connect Care 3 Empowering a healthier workforce 2023 – 2024 Health Benefits Guide 28 Pharmacy Coverage Some prescription drugs require prior authorization. This ensures you achieve the maximum clinical benefit
from the use of specific targeted drugs. Your physician or pharmacist must call to begin the prior authorization process. For the most up-to-date prior authorization list, visit Prescription Drug Copay: Brand Name vs. Generic Equivalent The copay is the dollar amount the pharmacy will collect for your prescriptions. If you choose a brand name prescription drug when a generic prescription drug is available, you will pay the appropriate copay plus the
difference in cost between the brand name and the generic drug. Copays are determined by the type of prescription drug purchased.
Home Delivery Pharmacy Helps Save You Money Home Delivery Pharmacy service offers a convenient and cost-effective way to fill prescriptions with fast, accurate home delivery. Plus, it is an easy way to save money on your maintenance medications. Once enrolled, you may take advantage of online self-service capabilities. Register at www.mycigna.com and have access to:
• Convenient switch to home delivery service
• Set-up automatic refills using Express Scripts Pharmacy from Cigna Healthcare
• View claims, balances and prescriptions history
• Manage account settings and payment methods
2023 – 2024 Health Benefits Guide 29 Dental Coverage Network: PDP Plus
DENTAL PLAN SUMMARY
Understanding Your Dental Benefits Plan Good dental hygiene is important for your overall health. The Preferred Dentist Program was designed to help you get the dental care you need and help lower your costs. You get benefits for a wide range of covered services – both in and out of the network. The goal is to deliver affordable protection for a healthier smile and a healthier you. Once enrolled, you may take advantage of online self-service capabilities. Register at
www.metlife.com/mybenefits and have access to:
• Check the status of your claims
• Locate a participating dentist
• Access MetLife’s Oral Health Library
• Elect to view your Explanation of Benefits online
2023 – 2024 Health Benefits Guide 30 Vision Coverage VISION PLAN BENEFIT SUMMARY (Group Number #51381)
DOWN LOAD
THEIR
MOBILE APP!
Search for NVA Vision or call 1-800-672-7723 *Does not apply to Wal-Mart/Sam’s Club or Lenscrafters locations or for certain proprietary brands.
**Does not apply to Wal-Mart/Sam’s Club, Lenscradters, Contact Fill (NVA Mail Order) or certain locations at: Target, Sears, Pearle, & K-Mart and may be prohibited by some manufacturers.
***Pre-approval from NVA required.
To verify your benefit eligibility, visit www.e-nva.com or download their mobile app. You may also contact Customer Service at 1-800-672-7723 (TDD line 1-888-820-2990) or the Interactive Voice Response (IVR).
Customer Service is available 24/7 and 365 days a year.
2023 – 2024 Health Benefits Guide 31 2023 – 2024 Health Benefits Guide 32 Note: This vision benefit summary is intended as a program overview only and is not a certified document of the individual plan parameters. Please contact Human Resources, for details.
On Your Way to Wellness The Human Resources Department is seeking volunteers to join our Wellness Committee. The purpose of this committee is to support all our efforts to enhance wellness throughout the Town:
• Improve an maintain your health, which is essential to enjoying a long life
• Reduce healthcare costs so that these dollars can be used for other purposes such as salaries, benefits and
Town services
• Increase the use of your preventive services; if you can identify an issue early on, it is much easier to
correct with a higher success rate (remember there are no copays!)
• Have fun with your co-workers competing in events and you can earn $$$!
Please contact Human Resources at kebaugh@townofcentreville.org, if interested.
Cigna Healthcare offers a variety of Wellness Programs; listed below are a few which may interest you and your family. These programs are free to you and any dependent enrolled in the health plan.
One-on-One Coaching As part of your health coverage, you have access to personal health coaching. To learn more about the coaching program, or to join, call 1-800-244-6224. You may receive a call inviting you to participate. We encourage you to take advantage of this voluntary and confidential phone-based program that can help you achieve your best possible health. Not only can you decide how involved you want to be, you also have the ability to leave the
program at any time.
2023 – 2024 Health Benefits Guide 33 Prepare for the Unthinkable Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance Town of Centreville provides Lincoln Term Life Insurance and Accidental Death and Dismemberment (AD&D) Insurance to all full-time eligible employees. The coverage is automatic and the premiums are 100% employer paid.
GROUP TERM LIFE AND AD&D BENEFIT SUMMARY
2023 – 2024 Health Benefits Guide 34 2023 – 2024 Health Benefits Guide 35 Protect Your Income!
Voluntary Life Insurance with Accidental Death and Dismemberment (AD&D)
SUMMARY
2023 – 2024 Health Benefits Guide 36 2023 – 2024 Health Benefits Guide 37 Additional Benefits AFLAC Benefits Employees may participate in an array of voluntary benefits including Accident, Cancer, Critical Care and Short-term Disability insurance. For more information, contact Matt Pastva, AFLAC Account Manager at 410- 463-4162.
Worker’s Compensation All employees are covered by Worker’s Compensation for injuries or illnesses occurring while performing normal work duties. For more information, refer to the Job-Injury Leave and Worker’s Compensation Reporting Process Policy in the Personnel Manual.
Vacation Leave Full-time employees earn vacation time based on years of service as outlined below.
• Zero through the end of 4 years of service: 4 hours per pay (Month = 8.67 hrs; Year = 104 hrs)
• Beginning the 5th year through 9 years of service: 6 hours per pay (Month = 13 hrs; Year = 156 hrs)
• Beginning the 10th year through duration of service: 8 hours per pay (Month = 17.33 hrs; Year = 208
hrs) Employees accrue vacation time in accordance with this schedule from date of hire and may begin using this time following six months of employment.
Sick Leave Full-time employees earn 4 hours of sick leave every pay period worked. Sick leave is prorated for part-time employees. Sick leave can be accumulated toward employee’s state retirement in that every 22 days of sick leave is counted as one month of service toward retirement.
Personal Leave Annually in January, full-time employees receive 24 hours of personal leave to use during the calendar year.
For employees hired after January, the personal hours are prorated.
Holidays Full-time employees receive 13 paid holidays annually. The recognized holidays are:
New Year’s Day Labor Day Dr. Martin Luther King, Jr. Day Columbus Day President’s Day Veteran’s Day Good Friday Thanksgiving Day Memorial Day Day After Thanksgiving Juneteenth Christmas Day Independence Day 2023 – 2024 Health Benefits Guide 38 Employee Assistance Program (EAP) Real support for real life. Confidential and no cost to you.
We recognize you may experience issues that affect your quality of life at home and at work, which has a great impact on your health. Cigna EAP provides access to work/life resources, and licenses clinicians to help you cope with a wide variety of concerns. Coverage is active for anyone who lives with the plan subscriber, including a nanny, parent, or in-law. Find out more by calling 1-800-244-6224, 24/7 or going online at
www.mycigna.com.
The EAP Can Help with Many Issues Including: Program Benefits Include:
• Workplace Stress • Up to 6 FREE counseling sessions with an
EAP professional for you and your
• Depression, stress, or anxiety
household members
• Coping with illness
• FREE financial consultation & referrals
• Adjusting to life challenges
• FREE legal consultation & referrals
• Marriage and Relationship concerns
• FREE childcare resources & referrals
• Drug and Alcohol dependency
• FREE eldercare resources & referrals
• And more!
• FREE online Resource Library, with
thousands of resources tailored to your specific life needs Benefits are free, voluntary and confidential. For more information about the EAP services through Cigna, contact Cigna Healthcare at 1-800-244-6224 or see your Human Resources Representative.
2023 – 2024 Health Benefits Guide 39 Retirement Plans – Planning Your Future Pension Plan Town of Centreville is a proud member of the Maryland State Retirement and Pension System. Full-time and permanent part-time employees are enrolled in the plan and contribute 7% of base annual salary on a pretax basis. Likewise, the Town makes a mandatory contribution. Employees are vested after 10 years with full
retirement and benefits paid after the employee has a combination of years of service and age totaling 90. The Law Enforcement Officers Pension System (LEOPS) is offered to sworn personnel working for the Centreville Police Department.
Deferred Compensation Plans To enhance retirement savings, employees have the option of participating in a deferred compensation program, also called a 457(b) plan. A 457(b) plan allows employees to set aside funds on a pretax basis for retirement.
The Town is happy to offer Mission Square and Corebridge Financial from which employees can select to invest.
Retiree Health Reimbursement Account (HRA) Stipend The Town offers eligible retirees to join the HRA if 10 years of service has been vested with the Town prior to their effective retirement date. Please review the Summary Plan Description (SPD) or contact Human Resources for more details.
2023 – 2024 Health Benefits Guide 40 Questions?
Your Benefits Contacts Benefit Contact Phone Website or Email General Benefit Human Resources 410-758-1180 kebaugh@townofcentreville.org Questions Medical and Cigna Healthcare 1-800-244-6224 www.mycigna.com Pharmacy Dental MetLife Customer Support 1-866-832-5756 www.metlife.com/mybenefits Vision NVA Customer Support 1-800-672-7723 www.e-nva.com 1-800-423-2765;
Life Insurance Lincoln Financial reference ID: www.LincolnFinancial.com
TOOFCEN2
1-800-423-2765;
Disability Lincoln Financial reference ID: www.LincolnFinancial.com Insurance
TOOFCEN2
Flexible Spending CareFlex 410-763-8787 www.careflex.com Account Matt Pastva, Account AFLAC 410-463-4162 Matthew_pastva@us.aflac.com Manager 457(b) – Def. Corebridge Financial 410-859-2164 Susan.gallant@corebridgefinancial.com Comp. Mission Square Retirement 800-669-7400 CSorokos@missionsq.org Maryland State Retirement Pension Plan 410-625-5555 www.sra.maryland.gov and Pension System Retiree HRA Human Resources 410-758-1180 kebaugh@townofcentreville.org
Stipend 2023 – 2024 Health Benefits Guide 41 Annual Notices 2023 – 2024 Health Benefits Guide 42 2023 – 2024 Health Benefits Guide 43 2023 – 2024 Health Benefits Guide 44 2023 – 2024 Health Benefits Guide 45 2023 – 2024 Health Benefits Guide 46 2023 – 2024 Health Benefits Guide 47 2023 – 2024 Health Benefits Guide 48 Helpful Contacts
AFLAC:
Matt Pastva, Account Manager Direct Line 410-463-4162 Email matthew_pastva@us.aflac.com Cigna Healthcare:
Accredo 1-877-826-7657 Benefits & Coverage 1-800-244-6224 Employee Assistance Program 24/7 1-800-244-6224 Health Information Line 1-855-673-3063 Health Reimbursement Account (HRA) 24/7 1-800-244-6224 Home Delivery Pharmacy 1-800-835-3784 Mental Health/Substance Use Coverage 1-800-433-5768 Medical Coverage 1-800-244-6224 MyCigna Website Help 1-800-853-2713 Traveling Abroad Coverage 1-866-763-8442 Cigna by Mail:
2023 – 2024 Health Benefits Guide 49 General Glossary of Terms AD&D Accidental Death & Dismemberment (AD&D) Insurance pays a benefit if you suffer certain types of injuries, such as the loss of a hand, foot, or eye as a result of an accident, or if you die as a result of an accident. AD&D coverage is automatically provided as part of your Basic Life Insurance.
Allowed Benefit The fee an insurance company has negotiated with a provider to charge for covered services. Payment for covered services is based on this negotiated amount.
Annual Benefits Election Period A designated timeframe for eligible employees to elect coverage who did not enroll during their initial eligibility period or for employees to make changes to their current benefits. Also referred to as Open Enrollment.
Basic Life Insurance The group term life insurance provided at no cost to eligible employees.
Beneficiary A person(s) or an entity (such as an association or organization) that you name to receive your life and AD&D insurance benefits if you die while covered; or to receive your vested account balances in your Retirement and Savings Program if you should die.
Brand Name Drug A drug sold under a patented name by one company. Not all products identified as a “brand name” by the manufacturer, Pharmacy or your Physician may be classified as a Brand Drug under the plan.
Calendar Year The period spanning from January 1 to December 31 of each year.
Coordination of Benefits (COB) A provision of the insurance industry which limits benefits if you are covered under multiple insurance plans. Benefits are limited to 100% of covered expenses. The order in which insurance companies are paid is also designated by this provision.
Coinsurance After you’ve reached your deductible, you and your plan share some of your medical costs. The portion of covered expenses you are responsible for is called Coinsurance. Coinsurance is not the same as, and does not include, copay.
Copayment (Copay) A flat fee you pay for certain covered services such as doctor’s visits or prescriptions.
Covered Expenses Charges that are paid in part, or in full, by the plan.
Deductible A flat dollar amount you must pay out of your own pocket before 2023 – 2024 Health Benefits Guide 50 your plan begins to pay for covered services.
Dependent The definition of a “dependent” will vary according to each plan.
Dependents under the medical, dental, vision, or health flexible spending plan are: 1) an employee’s law spouse; and 2) and employee’s child who a) is less than 26 years old, b) 26 or more years old, unmarried, and primarily supported by you and incapable of self-sustaining employment by reason of mental or physical disability which arose while the child was covered as a Dependent under this Plan, or while covered as a dependent under
a prior plan with no break in coverage. Please contact Human Resources for details.
Dependent Care Expenses Monthly expenses charged by a daycare provider (maximum of $5,000 per plan year) who is not your spouse, or someone claimed by you as a dependent.
Fiscal Year A fiscal year is a 12-month accounting period that a business uses for financial and tax reporting purposes. A fiscal year is also known as a financial year. The Town recognizes their fiscal year beginning July 1 and ending June 30 of the following year. The benefit plan year follows the Town’s fiscal year for budgeting purposes.
Flexible Spending Account (FSA) Flexible Spending Account (FSA) allows you to set aside pre-tax dollars for unreimbursed medical, prescription, vision, and dental expenses, and dependent care costs.
Generic Drug A drug that may be sold under more than one name, by more than one company. Not all products identified as a “generic” by the manufacturer, Pharmacy or your Physician may be classified as a Generic Drug under the plan.
Guaranteed Issue A provision that allows you to purchase insurance coverage regardless of the health of you and/or your spouse.
Health Reimbursement Account (HRA) An employer-funded account that helps pay for qualified health care expenses.
In-Network Benefits Benefits that are paid at a higher level when you use network participating providers.
Long-Term Disability (LTD) This type of insurance provides a percentage of your income if you become totally disabled. It is intended to protect your income for a long duration after you have depleted short-term disability or any sick leave your company may offer.
Medical Evidence of Insurability If you do not purchase life insurance when it is first offered, or within 30 days of your date of eligibility, you must complete a health questionnaire in order to be approved for the plan, thus 2023 – 2024 Health Benefits Guide 51 providing evidence that you are insurable. The insurance company will review your health information and determine whether or not they will provide coverage to you. The insurance
company may take several months to determine whether or not they will provide you with coverage.
Non-Preferred Provider A provider who does not have any agreement with your insurance plan to accept copays or reduced fees for services rendered.
Open Access Plus (OAP) Network Is a group of doctors, hospitals, facilities and labs that have contracted with your plan, and is located across the United States.
Open Enrollment See “Annual Benefits Election Period”.
Out-of-Pocket Maximum Specific limits for the total amount you will pay out of your own pocket before your plan coinsurance percentage no longer applies.
Once you meet these maximums, your plan then pays 100% of the “Maximum Reimbursable Charges” or negotiated fees for covered services.
Out-of-Network Benefits Benefits that are paid at a lower level when you use out-ofnetwork providers.
Participating Provider A provider that has a direct or indirect contractual arrangement with Cigna to provide covered services and/or supplies, the Chares for which are Covered Expenses. It includes an entity that has directly or indirectly contracted with Cigna to arrange, through contracts with providers of services and/or supplies, for the provision of any services and/or supplies, the Charges for
which are Covered Expenses.
Place of Service Your plan pays based on where you receive services. For example, for hospital stays, your coverage is paid at the inpatient level.
Plan Year The period spanning from the beginning of the benefit plan year to the end of the benefit plan year. Currently for Town of Centreville this is from July 1 to June 30 of the following year.
Plan Document A comprehensive written instruction describing the operation and administration of an employer’s plan. The plan document is written in legalese and may be difficult for the average participant to read and understand. Section 402 of ERISA requires that benefit plans subject to the regulations must be established and maintained according to a written instrument. The plan document tells the plan participants about the benefits they are entitled to
under the plan and provides guidelines to be used by the plan administrator in decision-making when it comes to plan operations. It is not required to be distributed to the participants unless requested.
2023 – 2024 Health Benefits Guide 52 Pre-Existing Condition Any health condition for which the patient has already received medical advice or treatment prior to the effective date of a new insurance plan. Benefits for this condition may not be paid for the first 12 months of coverage. See specific plan details of the benefit plan for more information.
Premium Only Plan (POP) Also referred to as “Section 125 Plan”. According to Internal Revenue Code (IRC) Section 125 to allow eligible employees to elect to pay for their portion of insurance premiums on a pre-tax basis. This Plan is for the exclusive benefit of the Participants and the Participant’s Beneficiaries. Refer to Plan Documents for participation eligibility requirements. Contact Human Resources
for more details.
Prescription Drug List The list of prescription brand and generic drugs covered by your pharmacy plan, or that by law must be dispensed with a prescription.
Qualifying Event An occurrence that entitles a person to select or change benefits outside of the defined “Open Enrollment” period. Events could include but are not limited to termination of employment, death of a covered person, marriage, divorce, birth, adoption, Medicare eligibility, a dependent child’s loss of dependent status, or commencement of or return from an unpaid leave of absence.
Short-Term Disability (STD) This type of insurance provides a percentage of your income if you become temporarily disabled.
Summary Plan Description (SPD) A summary of the plan document required to be written in such a way that the participants of the benefits plan can easily understand it. SPD is required to be distributed to plan participants.
Transition of Care Provides in-network health coverage to new customers when the customer’s doctor is not part of the Cigna network and there are approved clinical reasons why the customer should continue to see the same doctor.
2023 – 2024 Health Benefits Guide 53